COSMELAN® UPDATE 2010
COSMELAN®: NON-HYDROQUINONE, DEPIGMENTATION AND ANTI-MELANIN MASK
FASTTRACK: Version 2, September 2009
1. DE-PIGMENTATION COSMELAN MASK:
Melasma affecting the face often needs protracted local treatment and cosmeceutical-cream application to induce a bleaching-result ( fade melanin) and to prevent recurrence. The COSMELAN® approach is based on robust science and shown to be effective clinically at BOLANDCELL and Salon Du Toit De Beaute in Cape Town. LEENYX® are stockists and distributors of Cosmelan®. Treatment often stretches over many months, and the approach has been documented in the medical literature (see Levy et al : Jnl of Cosmetic Dermatology 4, 272-276, 2005) .Client selection is important and persons with sensitive skins need identification. Melasma, or acquired hypermelanosis will respond to Cosmelan® in most clients and is preferred to harsh treatment with lasers.
2. DE-PIGMENTATION NEEDLE-FREE MESOTHERAPY:
Alternatively, the TMT System™ can be considered which incorporates the MELANOGEL COMPLEX SYSTEM PROGRAM® ( see illustration). Also effective for the treatment in the salon , in preference to lasers, and far safer( see http://www.tmtsystem.net/ ). This is effective for cosmetic de-pigmenting treatment and the basis of treatment is called electroporation, non-needle transfer of cosmetic products into the dermis by the use of micro-currents. This process speeds up transcutaneous transfer of products into the skin, without a needle prick. After-care at home: Use Antispot cream and Melanogel Touch (Grupo Body_esthetic Laboratories, Barcelona, Spain: www.bodyesthetic.net) . LEENYX TECHNOLOGIES are the distributors in Cape Town and South Africa.
Melasma is frustrating to treat because of resistance to treatment and gradual recurrence. Sunscreen protection is important. Hormonal factors are important, and should be considered in the differential diagnosis. Melasma responds to monotherapy and combination therapy, including Cosmelan®. Hydroquinone topically, is also effective ( with or without IPL) , but is not authorised for use in Europe. Treatment often stretches over months and even years in some clients. Persons with sensitive skins must be screened out before the application of Cosmelan®. Variability of results and outcome and duration of treatment need to be discussed during the cosmetic interview.
BACKGROUND TO COSMELAN® DEPIGMENTING TREATMENT:
Treatment of hyper-pigmentation is the Achilles heel of the salon, beauty clinic, and aesthetic physician. The treatment of dark brown spots, and hyper-pigmentation especially on the face is challenging with almost all treatments rendering, non-lasting, modest and variable results. This will include treatment options for melasma, chloasma, lentigens and post-inflammatory hyper-pigmentation precipitated by acne. IPL and fractional laser therapy invariably cause post-inflammatory hyper-pigmentation, create client dissatisfaction and worsen the situation. The Krulig-Peel, pioneered by Dr Eduardo Krulig, a plastic surgeon from Venezuela, is the fore-runner of the Cosmelan® Peel. The Cosmelan® Peel is a two tier approach, that starts in the physicians rooms with medical supervision, and then is completed, daily, by the client at home over several weeks. In the physicians rooms the peel-mask is initially applied like a mud after skin assessment, then the client goes home and continues with moisturizers, maintenance Cosmelan®II cream and sun-block. Depending on the skin-classification, the Cosmelan® 1 mud is applied for periods ranging from 4-8 hours. The Cosmelan® Pack or kit consists of creams 1 and 2, an anti-oily solution, and Hydra-vital factor K (including Vitamin-E, which optimalises skin moisture and elasticity after the initial peel) and costs about R3000.The manufacturer of Cosmelan® is Mesoestetic®, Barcelona, Spain. Features typical of a peel include redness, stinging and burning, flaking and exfoliation. The product has properties that inhibit tyrosinase and therefore human melanin, thereby lightening brown-spots ( also called Ouma –Spots) . BOLANDCELL have experience with The Cosmelan® approach, and support the continued use thereof in selected persons presenting with melasma. The Cosmelan® Peel can be effective for to-days working women on a tight budget, but is a timely process.
WHAT OPTION OF FACIAL REJUVENATION APART FROM COSMELAN®?
BOLANDCELL has, via a beauty audit, detected that many of to-days modern woman, a touch over 35-years, and starting to show scary signs of facial wear and tear due to life pressures and reducing protective hormones, want facial rejuvenation to turn back the clock or at least preserve the face, but are bewildered by the wide selection of options and poor professional and inexperienced advice. Understandable. One cannot just go for laser therapy and end up with a scarred face, no result and an empty pocket. Too much, too fast. Not every woman needs cosmetic surgery, fractional laser or IPL, and one can go a long way with simpler cost-effective aesthetic options. The back-bone of aesthetic medicine, apart from Botox® or Juvederm Ultra®, is one or other superficial facial skin peel. Many prefer a “ lunch-time” or morning peel and photofacial, no down time, want a sparkle and glowing face, before fetching their children at school or returning to the office. Most peels and photofacial take about 1.5 hours. Neostrata® is well positioned to offer a quality peel together with excellent, super, back-up cosmetic creams at affordable prices. BOLANDCELL directs client driven peels and women of all backgrounds find this a valuable experience and educational. The ugly, tiny veins around the nose can be buzzed at the same time, by IPL, at no extra cost. The Cosmelan® Peel has become popular in the treatment of hypermelanosis.
BOTTOM LINE FOR MODERN FEMALE ACHIEVERS IN INDUSTRY SEEKING FACIAL REJUVENATION: DOES NON-SURGICAL COSMETIC TREATMENT WORK FOR EVERYONE?
- Get a decent and professional pre-peel consultation, including affordable and realistic options.
- Talk about the disadvantages of chemical peels: cannot remove deep wrinkles, cannot reverse the scarring of acne pocks, cannot repair severe sun damage, cannot lift the skin (after Mark Lees, 2007).
- Talk about the advantages of peels: can improve the skin-texture, can even the colouring, can help lighten hyperpigmentation, can improve fine-lines and rough-textures (after Mark Lees, 2007). Cosmelan®, is directed at lightening hyper-pigmentation of the face and also offers subtle rejuvenation properties. You may need home-treatment before a peel, but this is not essential with modern peels in the hands of an expert. Stay out the sun and wear sun-block and a broad-rim hat to avoid solar damage and formation of ugly brown patches ( See Neostrata advert).
- Talk about a photofacial and the benefits thereof (safe treatment).
- Talk about hazards of IPL, and fractional laser-therapy, especially in young people.
- Botox® and Juvederm® are here to stay, but will stretch the budget-pocket a little.
- You need affordable cosmeceuticals consisting of an eye-cream, day-protection cream, and bionic serum for step-outs (See cosmetic advert). BOLANDCELL can demonstrate state of the art creams launched by Neostrata® from the United States of America, at affordable prices.
LITERATURE REVIEW REGARDING COSMELAN® DEPIGMENTATION TREATMENT:
- Dr Eduardo Krulig, a plastic-surgeon, from Venezuela pioneered the use of the anti-hyperpigmentation mask-cream , Amelan®, now distributed locally under the brand-name Cosmelan®. The application of Amelan® to the skin of the face was always done under strict medical surveillance. In some clinics it was referred to as the “Amelan Peel”. Medical and cosmetic trials show that Amelan® does work ( See references).
- The original Amelan-Krulig treatment, by blocking tyrosinase, and thereby inhibiting melanin production in the melanosmes, was effective in the treatment of melasma, with visible improvement of the skin within 8 days (www.amelan.com), according to the manufacturer. In those patients treated, modest skin-tightness, redness, flaking and peeling was observed, confirming that the procedure, apart from the anti-melanin effect, also had chemical peel characteristics or keratolytic effect. Also termed Dermamelan® ( administered by doctors), and the option is offered in Hadleigh Clinics in the UK ( www.hadleighclinic.com). Cost is about 750 pounds per treatment and therefore needs budgeting for in the economic recession. In the United States, the Cosmelan® Peel and treatment costs $795-895. In South Africa, prices vary between R3000 and R4000, depending on the beauty-salon.
- To get rid of brown-spots on the face, the Cosmelan-Peel is a good and sensible first-step before considering lasers( www.rejuvalife.md) . There are many advantages to the treatment including, efficacy in almost all forms of melasma, rapid onset, compatible with most skin types (Fitzpatrick I to VI), no hydroquinone or TCA, with high safety-margin. Visible skin-results are detectable in one-week, with reduction of age-spots and other blemishes (www.beautyblogtalk.com, www.skinclinic.us). A recent consumer audit on Cosmelan® revealed out of 60 replies: thumbs up 6, 34 thumbs down, and 20 neutral. In some blogs, clients complained about the efficacy of new formulation Cosmelan®, and this may be explained by possible changes in product content. Some users only reported minimal results, and were annoyed because of the high costs. Other units report effective results after using the Cosmelan Depigmentation Peel
(www.fullrtondermatology.com). So, the therapist needs to look at the aspirations of each client.
- In South-Africa, the Cosmelan Pack can be obtained from the distributor, LEENYX, in Bellville, Cape Town
(www.leenyx.co.za) . For depigmentation, they have in stock, Dermamelan® Treatment Pack, Dermamelan® mask, Dermamelan® maintenance cream, Cosmelan® Treatment Pack and Cosmelan® Maintenance cream. Visit the manufacturing site at www.mesoestetic.com.
- The active ingredients have been gleaned from other Internet sites: COSMELAN® 1: Azalaic acid, Kojic acid, phytic acid, ascorbic acid, arbutine, titanium and retinyl palmitate. COSMELAN® 2: titanium dioxide, kojic acid, phytic acid and ascorbic acid.
- The application of topical skin-whiteners such as Kojic acid, Amelan®, azelaic acid, topical tretinoin, glycolic acid and hydroquinone have appeared in the medical literature and the results show variable degrees of success.
COSMELAN GIRL: HAIR REMOVAL WITHOUT NEED FOR LASERS OR IPL
Apart from skin hyper-pigmentation, hair removal from the extremities, upper-lip, chin, back and pudenda remain important components of aesthetic medicine and salon-therapy. There is now an important alternative-option to laser-hair removal.
The most cost-effective customary way of removing the hair has been by shaving and waxing. The draw back has been discomfort, hair re-growth and stubbles. Salon-clients want a more permanent result and sometimes opt for IPL or laser hair removal. This requires many treatment sessions over months and can be quite painful, not to mention the costs. This scenario has changed, and rapid hair removal can now be accomplished in the comfort of your home (within minutes and without any pain). On the face, older laser-models could not effectively remove white-hair. New-generation lasers are better at non-pigmented hair removal, but the process is costly.
To-day there is no need for laser hair-removal and there is a far cheaper and effective option. BLUE STEEL™ HAIR REMOVING LOTION is highly effective and works in 5-minutes. Apply and wipe away the long-hairs in 5-minutes. The new improved formulation, is used for all over body use, and renders harsh and prolonged treatment with lasers, obsolete. Simply apply to the hair-bearing surfaces and wipe-off in 5-minutes. All the hairs are virtually gone. In the hands of experienced cyclists, the lower extremities and back can be totally cleared of hair within minutes and with no pain. The manufacturers recommend avoidance of sensitive and facial areas. A 24-hour test patch can be considered in persons with allergies. For more details refer to firstname.lastname@example.org or consult www.leechem.co.za. The distributors can be contacted at: LEE-CHEM LABORATORIES (PTY), LTD (Mayville, Durban) or TWIN TRENDS (PTY) LTD, New South Wales, Australia. The hair-removal lotion that is highly effective can be purchased at Dischem Pharmacies in South Africa. The lotion packed in 100ml tubes, lasts for months.
SUMMARY: “Blue-Steel™ effectively removes unwanted hair from legs, arms, chest, back and other large areas” according to the distributors. In practice, this hair removing lotion has proved very effective for cyclists and other sportsmen.
FACIAL ANTI-AGING TREATMENT BY NEEDLE-FREE MESOTHERAPY
There are other non-invasive modalities now available for facial-rejuvenation, apart from fractionated-lasers or RF, IPL, and surgical face-lift. Needle-free mesotherapy can be considered after careful face-evaluation and mapping. The TMT-System™ is effective for facial-rejuvenation and application of anti-aging treatment. The distributors of the device in South Africa are Leenyx, a Cape Town based company. Grupo Body_ esthetic Laboratories, in Barcelona , Spain are the manufacturers. The following needle-free therapies (using the electroporation needle-free principle that enhances transfer of substances into the skin) are available in Cape Town:
- Antiaging program: glycosaminoglycans, ascorbic acid and hyaluronic acid)
- Facial-Repair-Regeneration ( post-solar program): hyaluronic acid
- Depigmentation ( Melanogel™ Complex System): kojic acid, salicylic acid, azelaic acid
- Reaffirming treatment ( anti-flaccidity program): ascorbic acid, deanol
BOLANDCELL PIGMENTATION REFERENCES: READING RESOURCES
- Stratigos AJ et al. Optimal management of recalcitrant disorders of hyperpigmentation in dark-skinned patients. Am J Clin Dermatol 2004:5, 161-8. (www.ncbi.nlm.nih.gov )
- Gupta AK et al. The treatment of melasma: A review of clinical trials. J Am Acad Dermatol 2006: 55;1048-65
- Levy JL et al. A double-blind controlled study of a non-hydroquinone bleaching cream in the treatment of melasma. Jnl Cosm. Derm 2005:4,272-276.
SUMMARY OF COSMELAN® HYPER-PIGMENTATION OR DE-PIGMENTATION PEEL TREATMENT:
- The Cosmelan® approach is effective and renders modest to good results in selected clients presenting with skin hyper-pigmentation, because the skin melanin formation is targeted.
- Cosmelan® works through the tyrosinase system and lightens the skin.
- One needs the mask ( COSMELAN® 1) and daily maintenance cream (COSMELAN® II): see www.rejuvalife.md
- The depigmentation process begins in the doctor’s rooms with the application of the mask after consultation and skin pre-assessment ( COSMELAN® I), followed by home maintenance therapy and application of COSMELAN® II and HYDRA-VITAL FACTOR K that contains vitamin E and biomineral salts on a daily basis
(MESOESTETICS: www.mesoestetic.com ).
- The treatment costs more compared to conventional peels. Not every client treated with Cosmelan® show reversal of skin pigmentation in one week, and the spots do not always disappear altogether, in persons with deep intradermal hypermelanosis. Occasionally the dark spots re-occur and are accentuated, and possibly explain why Cosmelan ® sometimes receives low scores on consumer review websites
DISCLAIMER: Terms and conditions apply. A medical doctor should always be consulted, or be on-site before considering aesthetic treatment, especially in persons with facial and extremity brown spots, lentigenes, etc. The reason is that the doctor needs to identify premalignant skin conditions, rule out malignant melanomas and amelanotic melanomas. Informed consent is needed for aesthetic treatment and with the manipulation of the skin pigment, as it may expose the client to a higher incidence of skin cancers because the protective light-barrier is destroyed by the lightening-agent allowing more UV-light to penetrate. If necessary, consult a dermatologist or plastic surgeon. Some components of skin brightners are proven carcinogenic in mouse and rat models, and this must be taken into account .
POSTED WITH WEBSITE UPGRADING: BIOMED RATED CONSULTANT: 3 DECEMBER 2008 AND REVISED 7 September 2009 ( Version 2).